Toxidromes nerve agents

In cholinergic syndromes, the presenting signs and symptoms are related to the build-up of acetylcholine (ACh) in the voluntary and autonomic nervous systems and the characteristic toxidrome has been described for many years. Most cases have been following pesticide exposure or pesticide self-poisoning, but there is also information about accidental and deliberate release of nerve agents. 

The agent used in the attack was not recognised until about 2.5 h after the attack when the classic nerve agent toxidrome was recognised by physicians who had attended the patients in the Matsumoto attack. 

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